Improving Child Behavior Using Task Shifting to Implement MFGs in Child Welfare

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Children with disruptive behavior difficulties reared by child welfare (CW)-involved families have an increased risk of future maltreatment and out-of-home placement. However, the lack of available providers and difficulties engaging families in mental health agencies frequently limit treatment access. Community-based organizations (CBOs) contracted by CW authorities to prevent out-of-home placement may be ideal locations to deliver child mental health Evidence-Based Practices (EBPs) as an adjunct to existing placement prevention services. As a result, CW-involved families' needs can be met comprehensively in one setting. Unfortunately, few EBPs have been successfully implemented in CW settings, especially those originally designed to be delivered by advanced mental health providers (i.e., Masters or PhDs). Given that CBO's typically employ bachelors'-level caseworkers who lack advanced mental health training, this is a significant barrier to implementation. As a potential solution, task shifting provides a practical and efficient strategy for facilitating implementation of EBPs where there are shortages of mental health professionals, involving (1) tailoring the EBP for provision by non- mental health providers; (2) training non-mental health providers in the tailored EBP; and (3) establishing regular supervision and monitoring of non-mental health providers by mental health specialists. The proposed R21 study will refine task-shifting strategies to implement an EBP to reduce child disruptive behavior difficulties, originally designed to be provided by advanced mental health practitioners (Masters or PhD), so that it can be delivered by bachelor's-level caseworkers in CBOs providing placement prevention services to CW-involved families. We will utilize the Multiple Family Group MFG (MFG) service delivery model to reduce child disruptive behavior disorders as the example EBP, because it has a beneficial impact on engagement, child behavior, and family processes when tested in community child mental health settings that provide services to CW-involved families. The proposed study aims are: (1) to use task shifting to tailor the content, training, and supervision of MFGs for delivery by bachelor's-level caseworkers in CBOs serving CW-involved families; and (2) to assess the feasibility and acceptability of the task-shifted MFGs in CBOs serving CW- involved families. The design and evaluation for this study are informed by the Practical, Robust, Implementation and Sustainability Model (PRISM) to support longer-term implementation efforts. We will use mixed quantitative and qualitative methods to assess for feasibility and acceptability from key stakeholders (caseworkers, supervisors, caregivers). By using the CW system as a non-specialty service sector platform to launch targeted mental health services, the proposed study will provide generalizable knowledge about using task shifting to facilitate cross-setting implementation for similar EBPs. Task shifting may also provide an innovative way to increase EBP access and reduce costs within transforming child-serving systems.